- Centers Plan for Healthy Living (Margate, FL)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists in… more
- Highmark Health (Tallahassee, FL)
- …Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior authorization , ... account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and disease management initiatives.… more
- Molina Healthcare (Tampa, FL)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- MyFlorida (St. Petersburg, FL)
- …Directions Behavioral Health program, review clinical notes match claims and authorization . Knowledge, skills and abilities, including utilization of equipment, ... Specialty Care. Develops procedures to evaluate medical necessity. + Evaluates authorization requests for specialty care referrals in accordance to the established… more
- Medtronic (Jacksonville, FL)
- …meetings + Own all portfolio assets, including new asset creation, existing asset management , and asset utilization planning + Form strong relationships with ... broad cross-functional knowledge, strong product experience, and comprehensive business management skills. This person will work closely with cross-functional teams… more
- Molina Healthcare (FL)
- …services to Molina members with ASD and other related disorders. * Approves prior authorization requests for BHT treatment by reviewing Behavioral Health Therapy ... Masters Degree in Behavior Analysis or a related field. **Preferred Experience** Utilization Management experience Health Plan/MCO work experience To all current… more
- Molina Healthcare (St. Petersburg, FL)
- …Services, pharmacies, and health plan providers in resolving member prescription claim, prior authorization , or pharmacy services access issues. + Articulates ... and state laws. Jobs in this family include those involved in formulary management (such as, reviewing drug/provider utilization patterns and pharmacy costs … more
- Molina Healthcare (Orlando, FL)
- …physician leadership and expertise in the performance of prior authorization , inpatient concurrent review, discharge planning, case management and ... years experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review,… more
- MyFlorida (Tallahassee, FL)
- …for preferred/non-preferred products; updates to claim edits; and system generated prior authorization criteria, based upon clinical practice guidelines and ... rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review boards, preferred drug lists, supplemental rebate contracts, and… more
- Prime Therapeutics (Tallahassee, FL)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... functions, DUR committees and responsibilities. + Supports elevated customer service and prior authorization inquiries specific to assigned accounts. + Manages… more